Totally laparoscopic right colectomy: theoretical and practical advantages over the laparo-assisted approach

The improvement in intracorporeal anastomotic techniques and the consequent switch from a laparo-assisted (LA) to a totally laparoscopic (TL) right colectomy seem to have overcome the initial concerns, giving rise to the widespread use of such a procedure. By comparing the LA and TL approaches, our study was aimed at verifying the possible advantages of the more recent technique, while also focusing on some technical implications for the surgeon.

We prospectively collected and matched data from 27 consecutive LA right colectomies and 28 consecutive TL right colectomies (TLRCs). Clinical, biochemical, pathological, and cosmetic parameters were examined. Operating times were recorded and analyzed, in order to evaluate the learning curve for the different phases of the procedure.

The LA and TL groups were homogeneous for demographic and pathological features. We had no mortality, and surgical complication rates were similar (3.6% versus 3.7%). The TLRC group presented a significantly shorter laparotomy (4.8 cm versus 7.2 cm, P=.002), whereas no significant difference was recorded for outcome parameters. Operating time for carrying out anastomosis was significantly longer for the TL group (55.6 minutes versus 20.6 minutes, P<.0001). A rapid decrease in anastomosis time throughout the series attests to a short learning curve for intracorporeal ileotransverse anastomosis.

Further studies are needed to demonstrate possible clinical advantages of TLRC over the LA approach. The cosmetic benefit for patients along with safety and the prospective usefulness for surgeons (practice in intracorporeal suturing techniques) would seem to justify an inclination toward this technical development.